When (and Whether) to Toast: Alcohol Research Review
You’re likely to field questions about alcohol and athletics. The best answers, as always, are those grounded in scientific research
As the weather chills and clients start unpacking their Halloween ghost-and-goblin decorations, they may also start uncorking some spirits . . . of the liquid variety. Made through fermentation of grains, fruits, honey or plants, alcohol has been used medicinally, socially and in religious ceremonies throughout history. It’s a cultural mainstay.
It isn’t without its problems, of course. According to the most recent statistics available from the National Council on Alcoholism and Drug Dependence, “Alcohol is the most commonly used addictive substance in the United States: 17.6 million people, or one in every 12 adults, suffer from alcohol abuse or dependence along with several million more who engage in risky, binge drinking patterns that could lead to alcohol problems” (NCADD 2015).
Interestingly, moderate alcohol consumption has been associated with some positive health outcomes in a wide range of studies conducted over the past several decades (see “Key Terms” for more detailed definitions pertaining to alcohol use). Every so often, new research emerges that piques the curiosity of clients from all walks of life. One study may cause people to wonder if it would be wise to begin adding a daily dose of spirits for health purposes, while another study might prompt those who do imbibe to rethink their choice. And then there are “athletic” events like 5K pub crawls that raise a whole new set of questions.
Without promoting drinking, how do you answer clients’ questions regarding use, nonuse, misuse or overuse of alcohol? What do you say to those who don’t yet drink but wonder if they should? Here’s a brief overview of the research.
Potential Benefits of Light-to-Moderate Alcohol Use
Studies have revealed some positives regarding moderate drinking and various aspects of health.
Editor’s note: In late August, The Lancet published a sweeping global study that rejects the idea that moderate drinking may have some benefits. No amount of alcohol is safe, according to this new research. We will report on the study in the next issue, in the meantime, you can read it at doi.org/10.1016/S0140-6736(18)31571-X.
Moderate consumption of alcohol has been linked with a reduced risk of development of and death from heart disease (NIAAA 2017), sometimes known as a cardioprotective effect. This is not new news: More than 15 years ago, a study associated moderate alcohol consumption with a reduced risk of coronary heart disease, total and ischemic stroke, and total mortality in middle-aged and elderly men and women (Agarwal 2002). The mechanisms by which this occurs include increased levels of high-density lipoprotein cholesterol (HDL), decreased levels of low-density lipoprotein cholesterol (LDL), clot formation prevention, reduction in platelet aggregation, and lowering of plasma apolipoprotein A concentration. Thus, alcohol was found to reduce the risk of coronary heart disease both by inhibiting the formation of plaque buildup in arteries and decreasing the rate of blood clotting (Agarwal 2002).
A meta-analysis published in BMC Medicine revealed that light and moderate alcohol consumption were associated with a lower risk of ischemic stroke (a stroke caused by a blockage) and were not linked to any type of hemorrhagic stroke (a stroke caused by a burst blood vessel). Experts theorized that changes in cholesterol profile (see Cardiovascular Health) may, in part, explain alcohol’s link to reduced risk of ischemic stroke (Larsson et al. 2016).
However, again, moderation is key: This same study found that drinking about three or four drinks (or more) per day was associated with increased risk of all types of stroke, especially hemorrhagic. This may be because as alcohol consumption increases, so does the risk of hypertension (high blood pressure), which in turn increases the likelihood of a burst blood vessel (Larsson et al. 2016).
Alcohol consumption triggers the release of endogenous opioids, such as endorphins, which can temporarily enhance one’s sense of well-being. Therefore, social consumption of alcohol may have effects similar to other endorphin-releasing social activities—including laughter, singing and dancing—that we use to reinforce social bonds (Dunbar et al. 2017).
Interestingly, a recent study of more than 9,000 British adults revealed that people between the ages of 23 and 55 who drank no more than 14 units (about 6 pints of low-alcohol beer or 6 medium-sized glasses of wine per week) and did not smoke reported the “best overall health and well-being across numerous indicators,” compared with other groups at various levels of alcohol and tobacco use, including “infrequent drinking/abstention.” However, light-to-moderate drinkers did not reap the same benefits if they had other risks, such as being a former smoker, having obesity or not exercising regularly (Staff & Maggs 2017; Miller 2017).
Potential Problems With Heavy Alcohol Use
It’s well known that there are many negative health consequences associated with habitual heavy alcohol consumption, or alcohol abuse. Chronic alcohol abuse is associated with pathophysiological changes in multiple organs, often resulting in life-threatening clinical outcomes—including breast and colon cancer, pancreatic disease, cirrhosis of the liver, diabetes, osteoporosis, arthritis, kidney disease, immune system dysfunction, hypertension, coronary artery disease, alcohol-induced cardiomyopathy, and heart failure, as well as central nervous system disorders (Dguzeh et al. 2018). Here are some additional study results.
BRAIN HEALTH AND FUNCTION
People with alcohol use disorder have a global loss of brain volume that is most severe in the frontal cortex. This likely contributes to the dysfunctional poor decisions associated with alcohol dependence (Crews & Vetreno 2014). Interestingly, in a study published in BMJ, even moderate drinkers (14–21 units weekly, where one unit is 10 milliliters) were more likely to show atrophy in gray matter and the right side of the hippocampus, as well as a faster decline in verbal fluency, compared with those who drank little to nothing (Topiwala et al. 2017).
Heavy alcohol use has been identified as a risk factor for many types of cancer, including breast, colorectal, liver and esophageal, in addition to cancers of the oral cavity, pharynx and larynx (Bagnardi et al. 2015).
Habitual high levels of alcohol consumption (more than two drinks per day for women and more than three drinks per day for men) are associated with an increased cardiovascular risk (including hypertension, cardiomyopathy and atrial fibrillation) and a higher risk of stroke (O’Keefe et al. 2014).
DIGESTIVE HEALTH AND IMMUNITY
Heavy alcohol use harms the gastrointestinal tract by damaging the mucosa of the esophagus and stomach, modifying sphincter pressure and impairing motility, altering gastric acid output and the gut microbiome, and harming the mucosal immune system (Rocco et al. 2014). While moderate alcohol consumption has been connected with reduced inflammation and improved vaccination responses, chronic heavy drinking is associated with a lower frequency of lymphocytes and an increased risk of both bacterial and viral infections (Barr et al. 2016).
Alcoholic liver disease (ALD) is a leading cause of cirrhosis and liver-related death worldwide. Early discoveries of ALD have identified increased levels of bacterial endotoxins in the portal circulation. Alcohol consumption can disrupt the intestinal epithelial barrier and result in increased gut permeability and inflammation (Szabo 2015).
According to the Centers for Disease Control and Prevention, approximately 88,000 Americans died of alcohol-related causes from 2006 through 2010, making excessive alcohol use the fourth leading preventable cause of death in the United States (Stahre et al. 2014). Here are some additional compelling stats on the worldwide impact of alcohol overuse, from the NIAAA website (2017):
- In 2010, alcohol misuse was the fifth leading risk factor for premature death and disability in the world.
- In 2012, 3.3 million global deaths were attributable to alcohol consumption.
- In 2014, the World Health Organization reported that alcohol contributed to more than 200 types of diseases and injury-related health conditions, including liver cirrhosis, cancers and injuries.
ALCOHOL USE DISORDER
Treating alcohol use disorder is a complex and challenging process, and the recovery process is a lifetime commitment. It often requires an integrative approach that may include residential treatment, medications, psychological and behavioral counseling, alternative medicine, support groups, and ongoing care from a physician (Mayo Clinic 2018).
Hold the Toast?
When it comes to drinking alcohol and expecting a health benefit, moderation is key. If your clients currently don’t drink alcohol, it may be in their best interest not to start for any perceived “health benefits,” as similar advantages can be achieved through living a healthy lifestyle that focuses on getting optimum amounts of sleep, managing stress, reducing exposure to environmental toxins, exercising regularly and eating a balanced diet.
Agarwal, D.P. 2002. Cardioprotective effects of light–moderate consumption of alcohol: A review of putative mechanisms. Alcohol and Alcoholism, 37 (5), 409–15.
AHA (American Heart Association). 2015. Alcohol and heart health. Accessed June 14, 2018: heart.org/HEARTORG/HealthyLiving/HealthyEating/Nutrition/Alcohol-and-Heart-Health_UCM_305173_Article.jsp#.WyLDKadKjIU.
Arranz, S., et al. 2012. Wine, beer, alcohol and polyphenols on cardiovascular disease and cancer. Nutrients, 4 (7), 759–81.
Bagnardi, V., et al. 2015. Alcohol consumption and site-specific cancer risk: A comprehensive dose-response meta-analysis. British Journal of Cancer, 112 (3), 580–93.
Barnes, M.J. 2014. Alcohol: Impact on sports performance and recovery in male athletes. Sports Medicine, 44 (7), 909–19.
Barr, T.M., et al. 2016. Opposing effects of alcohol on the immune system. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 65, 242–51.
Crews, F.T., & Vetreno, R.P. 2014. Neuroimmune basis of alcoholic brain damage. International Review of Neurobiology, 118, 315–57.
Dguzeh, U., et al. 2018. Alcoholism: A multi-systemic cellular insult to organs. International Journal of Environmental Research and Public Health, 15 (6), 1083.
Dunbar, R.I., et al. 2017. Functional benefits of (modest) alcohol consumption. Adaptive Human Behavior and Physiology, 3 (2), 118–33.
Duplanty, A.A., et al. 2017. Effect of acute alcohol ingestion on resistance exercise-induced mTORC1 signaling in human muscle. The Journal of Strength & Conditioning Research, 31 (1), 54–61.
Jiménez-Pavón, D., et al. 2015. Effects of a moderate intake of beer on markers of hydration after exercise in the heat: A crossover study. Journal of the International Society of Sports Nutrition, 12 (26).
Larsson, S.C., et al. 2016. Differing association of alcohol consumption with different stroke types: A systematic review and meta-analysis. BMC Medicine. Accessed June 19, 2018: bmcmedicine.biomedcentral.com/articles/10.1186/s12916-016-0721-4.
Mayo Clinic. 2018. Alcohol use disorder. Accessed June 18, 2018: mayoclinic.org/diseases-conditions/alcohol-use-disorder/diagnosis-treatment/drc-20369250.
Miller, M. 2017. Health benefits of moderate drinking
may be overstated, study finds. Penn State News. Accessed June 18, 2018: news.psu.edu/story/469164/2017/05/24/research/health-benefits-moderate-drinking-may-be-overstated-study-finds.
NCADD (National Council on Alcoholism and Drug Dependence). 2015. Facts about alcohol. Accessed June 14, 2018: ncadd.org/about-addiction/alcohol/facts-about-alcohol.
NIAAA (National Institute on Alcohol Abuse and Alcoholism). 2017. Alcohol facts and statistics. Accessed June 14, 2018: niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-facts-and-statistics.
O’Keefe, J.H., et al. 2014. Alcohol and cardiovascular health: The dose makes the poison . . . or the remedy. Mayo Clinic Proceedings, 89 (3), 382–93.
ONDCP (Office of National Drug Control Policy). 2017. Changing the Language of Addiction. Accessed June 18, 2018:
Rocco, A., et al. 2014. Alcoholic disease: Liver and beyond. World Journal of Gastroenterology, 20 (40), 14652–59.
Staff, J., & Maggs, J. 2017. Alcohol and cigarette use from ages 23 to 55: Links with health and well-being in the long-term national child development study. Journal of Studies on Alcohol and Drugs, 78 (3), 394–403.
Stahre, M., et al. 2014. Contribution of excessive alcohol consumption to deaths and years of potential life lost in the United States. Preventing Chronic Disease, 11, e109.
Szabo, G. 2015. Gut–liver axis in alcoholic liver disease. Gastroenterology, 148 (1), 30–36.
Topiwala, A., et al. 2017. Moderate alcohol consumption as risk factor for adverse brain outcomes and cognitive decline: Longitudinal cohort study. BMJ, 357, j2353.
Traversy, G., & Chaput, J-P. 2015. Alcohol consumption and obesity: An update. Current Obesity Reports, 4 (1), 122–30.
USDHHS & USDA (U.S. Department of Health and Human Services & U.S. Department of Agriculture). 2015. 2015–2020 Dietary Guidelines for Americans. Accessed June 18, 2018: health.gov/dietaryguidelines/2015/guidelines/, p. xiii.
Vella, L.D., & Cameron-Smith, D. 2010. Alcohol, athletic performance and recovery. Nutrients, 2 (8), 781–89.